Liver involvement in patients with COVID-19 infection: A comprehensive overview of diagnostic imaging features

Abstract

During the first wave of the pandemic, coronavirus disease 2019 (COVID-19) infection has been considered mainly as a pulmonary infection. However, different clinical and radiological manifestations were observed over time, including involvement of abdominal organs. Nowadays, the liver is considered one of the main affected abdominal organs. Hepatic involvement may be caused by either a direct damage by the virus or an indirect damage related to COVID-19 induced thrombosis or to the use of different drugs. After clinical assessment, radiology plays a key role in the evaluation of liver involvement. Ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) may be used to evaluate liver involvement. US is widely available and it is considered the first-line technique to assess liver involvement in COVID-19 infection, in particular liver steatosis and portal-vein thrombosis. CT and MRI are used as second- and third-line techniques, respectively, considering their higher sensitivity and specificity compared to US for assessment of both parenchyma and vascularization. This review aims to the spectrum of COVID-19 liver involvement and the most common imaging features of COVID-19 liver damage.

Insight into COVID-19 associated liver injury: Mechanisms, evaluation, and clinical implications

“…These include ultrasound (US) (main diagnostic tool for first evaluation), Computed Tomography Scan (CT) (most useful for overall abdominal assessment) and Magnetic Resonance Imaging (MRI) (most helpful in better clarifying liver changes in cases where changes on US and CT are indeterminate). Hepatomegaly, steatosis, acute hepatitis, drug induced liver injury, portal vein thrombosis and biliary involvement have all been described 8 . Liver injury has also been corroborated from liver biopsy evidence which have showed moderate microvascular steatosis and mild lobular and portal activity 9 .…”

“…Hepatomegaly, steatosis, acute hepatitis, drug-induced liver injury, portal vein thrombosis, and biliary involvement have all been described. [ 8 ] Liver injury has also been corroborated from liver biopsy evidence, which has shown moderate microvascular steatosis and mild lobular and portal activity. [ 9 ] It is of utmost importance for physicians and researchers to analyze and assess the mechanism of liver injury and its impact on patient outcomes and disease processes.…”